| Granger Pediatric Dentistry | |
|
3725 W. 4100 S. Suite #260 West Valley City UT 84120 | |
| (801) 969-8881 | |
| (801) 969-8889 |
| Full Name | Granger Pediatric Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3725 W. 4100 S., West Valley City, Utah |
| Authorized Official Name and Position | Jason J Horgesheimer (DR/OWNER) |
| Authorized Official Contact | 8019698881 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Granger Pediatric Dentistry P.o. Box 18430 Salt Lake City UT 84118-0430 Ph: (801) 969-8881 | Granger Pediatric Dentistry 3725 W. 4100 S. Suite #260 West Valley City UT 84120 Ph: (801) 969-8881 |
| NPI Number | 1154637825 |
|---|---|
| Provider Enumeration Date | 08/19/2010 |
| Last Update Date | 11/27/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154637825 | NPI | - | NPPES |
| 526155793003 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 360305-9923 (Utah) | Primary |
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